Rancho Hospital’s Future Still Uncertain

A federal judge on Monday gave Los Angeles County another week to make its case for closing Rancho Los Amigos National Rehabilitation Center, a respected hospital that treats patients disabled by severe head or spinal injuries.

The county hopes to shut Rancho by June 30 as part of a broader plan to save money throughout its troubled public health system. In a tentative ruling issued Friday, U.S. District Judge Florence-Marie Cooper indicated her intention to block Rancho’s closure until the county proves that disabled Medi-Cal patients could obtain comparable care elsewhere.

In a hushed courtroom Monday morning, the judge reiterated her concerns to county attorneys and patient advocates. She also noted that “timing is of the essence” as the county made plans to notify Rancho patients Thursday of the impending closure.

But after listening to brief arguments from both sides, she agreed to allow more time in order to review the county’s assertion that it is not required to guarantee Medi-Cal beneficiaries access to health services. Medi-Cal is California’s version of Medicaid, the federal program that provides medical coverage for the poor.

County lawyers contend that because the state administers Medi-Cal, setting payment rates and eligibility rules, the county cannot control whether patients receive adequate care.

Melinda Bird, an attorney representing the disabled patients, countered that as long as the county agrees to participate in the federal Medicaid program, it must adhere to the “core principle” that Medi-Cal patients are entitled to the same access to medical care as privately insured patients. “Closing Rancho Los Amigos will defeat the core principle of the Medicaid program by denying access to thousands of patients,” Bird told the court.

Since neither the plaintiffs nor the state’s attorneys had reviewed the county’s latest court filing, the judge agreed to hold off on deciding whether to grant a preliminary injunction halting Rancho’s closure. The parties will return to court May 5.

Rancho Los Amigos serves more than 9,500 patients per year, about half of them Medi-Cal recipients. At Rancho, the county has concentrated its services for disabled patients needing specialized care.

In her tentative ruling, the judge found that those patients “will not be able to obtain adequate substitute care at surviving hospitals or other settings” if the Downey hospital closes.

The county’s public health network is already laboring under the weight of a vast population of uninsured patients. Faced with a projected $709-million budget gap over the next three years, the Board of Supervisors approved Rancho’s closure along with a series of other hospital and clinic cuts.

Last month, disability rights advocates filed a federal suit seeking to keep Rancho open. They argued that closing the hospital would violate the federal Americans With Disabilities Act by denying treatment to hundreds of disabled patients.

The county Department of Health Services has already curtailed new admissions to the hospital. “If it is estimated that their length of stay will exceed June 30, they would not be admitted,” said department spokesman John Wallace.

Unions representing health workers report that Rancho’s cutbacks have already begun to ripple through the overloaded system. If a patient is paralyzed by a gunshot wound, for example, he might be stabilized at County-USC Medical Center but then transferred to Rancho for physical therapy and other rehabilitation. But with admissions limited at Rancho, hospital beds at County-USC, Martin Luther King/Drew Medical Center, and other trauma centers are filling up with patients who need extensive rehab care. Rancho’s inpatient caseload, meanwhile, has fallen from more than 200 to 140 patients, Wallace said.

If a court order thwarts the county’s effort to close Rancho, said Director Thomas Garthwaite, “We’re going back to the drawing board” to find fresh cuts to balance the budget.

In a related development Monday, the California Community Foundation released a study showing that Rancho could succeed as a nonprofit hospital, operating in the black within one year. That alternative could prove attractive to county leaders if the court rules that Rancho must remain open.

The best-case scenario, the foundation report said, is for an existing hospital or health care system in the L.A. area to assume operation of the rehabilitation center. Such a conversion would take at least 12 months. Even with a yearlong grace period, however, a new Rancho would still face significant obstacles, the report concluded. Chief among them are maintaining the staff at its current level of expertise and finding money to operate the hospital during the transition period.

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Times staff writer Lisa Richardson contributed to this report.